Saturday, 2 May 2009

Swine flu, world poverty and childhood vaccinations! Oh my!

In 2006 I went to concert put on Dr. Beat Richner. Richner had dedicated his life to setting up children's hospitals in Cambodia. He was there that fateful day in April 1975 when the Khmer Rouge took over the city not to return until the 1990s to continue his work. His concerts were mostly a way to get wealthy tourists to part with their money and the young healthy backpackers to give a pint of blood for his children's hospitals in the capital and Siem Reap, the tourist town that services the Angkor Watt temples.

What really stuck with me during the talk was that he noted that a few years previously his concerts had almost no tourists due to the outbreak of SARS and bird flu starving his hospital and the Cambodian economy of much needed funds. During that time far more Cambodian children would die of preventable illnesses than the numbers of people who died during the previous two round of pandemics.

So what's all this got to do with the latest virus that is going to be the end of mankind as we know it?


Two things.

Firstly I think the reason why the mortality rate for the latest virus is so high in Mexico is because many people in Mexico don't have the luxury of good nutrition, housing and ready access to health care that we all take for granted and which contributes to our ability to fight disease. While there is as Russell Brown points out be history here, the approach of our local newsmedia has taken in reporting the outbreak might be good tamiflu sales here in New Zealand, but that doesn't necessarily make us any safer. Particularly if the sick people are infecting others in the pharmacies buying their tamiflu or even worse, we end up with a strain resistant to the current anti-viral drugs due to people taking the medication when they don't need it.

More importantly the deaths of all those thousands of people from boring diseases such as malaria, polio and whooping cough go unnoticed in the hysteria. This isn't just a third world thing. New Zealand's immunisation rate is appalling. I'm not sure why our rates are so low especially in comparison to the United States which isn't famous for accessible health care. I do know there is a strident group of parents who choose not to adhere to the vaccination schedule for their kids.

I'm going to come right out and say that I have little tolerance for people who knowingly choose to forgo childhood vaccinations for their children.

I'm sure many regular readers may find this opinion at odds with my general view of parenting decisions (breastfeeding, homeschooling, or indeed having kids in the first place) in that I generally think it's up to individuals to figure out what works best for them and their kids and ignore all the people who are screaming at that they're doing it wrong.

But when it comes to vaccinations I'm not so tolerant.

I understand that many parents might be concerned about immunizations after reading the horror stories about children who developed symptoms of autism around the same time as they were given their childhood vaccinations. Not to mention the stories about children suffered terrible fevers and rashes and sometimes seizures post-jab that undoubtedly do the rounds at coffee groups. These stories will naturally have raised some questions for parents and I can see why this fear may lead some of them choose not to vaccinate their kid.

But if you talk to your grandparent's generation, you might find a different set of horror stories.

That in just a two generations we no longer have to fear death from diseases like measles or polio or whooping cough is a miracle made possible by modern medicine. The thing that irks me about the anti-immunization crowd is that as the number of parents who choose not to vaccinate their children increases so does the likelihood that these diseases will become a problem again. Parents who decide that the risks are too great to vaccinate their kids are counting on the rest of the population who are willing to take those risks to decrease the chances that their child will be exposed to these diseases. Moreover their decision to not jab does have real effects on other parents.

Like the parents who take their baby into the doctor's office around the same time as the kid presenting with a case of the measles who came into contact with the disease overseas. It goes without saying that the immune system of baby isn't as well-developed as that of an older child and the repercussions of such an infection could result in death for the infant.

Let us not forgot many millions of parents around simply don't have that choice because they can't afford the jabs in the first place. Because let's face it, the ability of parents to refuse vaccinations really is a first world luxury. We have access to healthcare if and when we need it, good nutrition and proper housing all of which lowers our chances of getting sick and much more importantly being able to get better when we do.

The influence of drug companies not to mention morality campaigners do make it difficult for people to make confident decisions about healthcare. Some vaccines and medications have undoubtedly been pushed on the public for little benefit and great expense while at the same time there are people who are forgoing the benefits of modern medicine due to public scaremongering and in many countries a lack of a cash.

I generally err on the side of 'better living through pharmacology' but I know there will be plenty of readers who will disagree me and I'd love to hear from you. Despite my rather militant ramblings, I'm pretty sure that most people want the same thing, healthy living for all of us.

29 comments:

Trouble said...

Hear hear. The saddest thing I've seen recently is a terrible NZ doco called Mercury Falling - completely irresponsible and scientifically illiterate reporting of a woman with two autistic sons who was convinced that vaccination and heavy metal poisoning was responsible for her sons' condition. She was so upset to think that she'd done the wrong thing, yet not even the reporter realised that her kids were too young to have been exposed to the supposed culprit, thiomersal, because it was taken out of vaccines just in case before her kids would have had it.

I think that's the key - people don't want to have done something to harm their kids, yet harming them or others by omission doesn't have that moral pang. Best intentions plus poor understanding of risk plus irresponsible advocacy equals low vaccination rates. Plus I think NZ has a more innate "screw you, authorities" culture on top of it all.

anna c said...

I think you start to get to the crux of the matter towards the end. Really, this isn't about the parents because the important decisions are not made at the individual level. Yes, parents can often decided whether or not their children should be vaccinated, but that's based on the (mis) information that's out there. With so much history of misinformation and coverups on the part of drugs companies, how is the average person meant to have any idea what is the best thing to do.

Personal interest: seven years ago I suffered major side effects to medical treatment which given my situation I should never, ever have been given. Now my attitude to medicine is based on the risk of something happening again versus the potential benefit; whilst I would seek medical treatment for something with a likelihood of killing me, I have no intention of doing so for anything much short of that.

So whilst I think vaccinations are generally a good idea, and would almost certainly have my (hypothetical) children vaccinated, I just can't blame the parents for this.

Re: our rates being so low, I believe that in the US children have to be vaccinated to attend school?

Anna said...

Couldn't agree more, E-E. The fear we currently feel about swine flu is felt by a good chunk of the world's population every single day, because they lack the basic care we're able to take for granted.

I had an interesting conversation with a Dutch workmate recently - he lived near a village populated by members of the Dutch Reform Church, who didn't believe in vaccinations. In the seventies, the village contracted polio, with horrific consequences. Perhaps it's because NZ is isolated and wasn't so directly ravaged by two world wars that the need for vaccinations hasn't been impressed on us so much?

It's worth pointing out that those who don't vaccinate are piggy-backing off those who do - not vaccinating is the luxury you have when you know the rest of the population is staving of the nasties for you.

Psycho Milt said...

I'm sure many regular readers may find this opinion at odds with my general view of parenting decisions ... in that I generally think it's up to individuals to figure out what works best for them...I don't see any conflict there. Refusing to vaccinate your children doesn't just affect you and your children, it affects the rest of us too. The rest of us are well entitled to take a dim view of it.

barvasfiend said...

A good term to throw in there is 'herd immunity' which basically describes the point at which all are reasonably protected from communicable diseases, through the vaccination of the majority.

New Zealand is in danger of falling below herd immunity levels because of the slack approach to vaccination.

Two observations I have from living in the US;

One; most first year students entering university are vaccinated for Hep A and B. This is pretty standard. not something we do on this side of the world.

And two; I saw a woman called Jenny McCarthy somethingorother famous actress with an autistic child mount a huge campaign against vaccination in the firm belief it had caused her son's autism. I watched an interview with her, where her position was countered by a couple of eminent scientists (with degrees even!).

I felt convinced that the audience would favour the science which seemed clear cut, but they all seemed to support McCarthy who put forward an impassioned case mostly oriented around her belief in her child's abilities and her 'mother's intuition'.

She was reaching out in a really frightening and compelling way to other parents of children with autism, and indeed other parents. I find this doubly frightening and also an issue of social justice; her stance is irresponsibly putting the burden of illness onto children and families already coping with autism.

But she was really shiny/blond and had excellent hair....

barvasfiend said...

And also, it's so good to see some perspective on this Swine flu business.

katy said...

"or even worse, we end up with a strain resistant to the current anti-viral drugs due to people taking the medication when they don't need it."

I am no molecular biologist but I don't think this can be avoided, can it? Given the nature of viruses (they mutate very quickly) isn't our only option to try and keep up? I was really struck by this when I went to a country which has a lot of malaria. My friend who had had malaria just a few years previously and the hard-core drugs that he had been treated with (resulting in blinding headaches etc) were, when I was planning to go, the prophylactic drugs. I was stunned at the speed at which medicine needed to move to keep up in order to be effective.

Getting back to parents and decisions to vaccinate, I know I would be terrified about making this decision and this is largely because there is so much we (as ordinary people) don't know about potential risks from vaccines etc. I posted on another thread about the kids in Japan who died after taking Tamiflu, what an awful position to be in as a parent, to have to try and weigh up risks while knowing you don't have access to all the info.

katy said...

ps I know malaria isn't a virus ;)

Moz said...

I do favour the US approach - you can choose not to vaccinate your kids, but the childcare facilities etc can choose to treat them as lepers (literally in this case, as people harbouring dangerous diseases). I'd be happy to see the kids restricted in choice of schools and so on just to preserve the sensible majority. Of course, that's punishing the children for the religion of their parents, but we already do that and people seem to be happy with it. One effect might be to swing the decision - sure, your kid might develop autism if you do vaccinate, but if they don't your kid will certainly not be allowed into childcare and will have to attend a school run by the mentally deficient. Much more interesting decision there, except for the parents who already choose such schools.

jo said...

okay so you almost made a link between terrible living conditions and the spread of infectious diseases but then you dropped it in favour of the more popular, "lets bash other parents who do things differently from us" approach. If you can admit that the reason so many people have and die from the flu (and lot's of them just the standard one that we all get every year too here) because of health,poverty, lack of healthy food etc etc. and then say VACCINES are the reason we don't have all though nasties here, well I simply don't agree..The 'victory over epidemics' was not won by medical science or by doctors and certainly not by vaccines. The decline has been the result of technical, social and hygienic improvements and especially of improved nutrition.
The vaccines are available to everyone at any point in their life and I don't see why we should be giving them to our children before they are able to consent, there is no immediate danger to any of us of getting any of the things that the vaccines carry because of the health standards we enjoy in this country. If I intended to take my children to countries where these vaccines are necessary of course they would have to be vaccinated, there is no immediate danger..but except what the vaccines themselves may pose, and there IS evidence to show that they are dangerous to some people, and also to all of us we may be yet to discover.

jo said...

Have to rewrite that last paragraph "If I intended to take my children to countries where these vaccines are necessary of course they would have to be vaccinated. There is no immediate danger here in NZ but except what the vaccines themselves may pose, and there IS evidence to show that they are dangerous to some people, and possibly also to all of us in ways we may be yet to discover."

Fi said...

As a result of a medical condition, my sister is unable to be vaccinated against some illnesses. The growing number of parents who choose not to vaccinate their children are effectively putting her at more risk than she otherwise needs to be.

I totally agree with Ex-expat on this - Yes, you can choose to wait to vaccinate until your child is old enough to choose, but then you have perhaps 12 years (or maybe more) when you are depending on other parents choosing to vaccinate to keep your child healthy.

By choosing not to vaccinate against rubella you could also be putting someone's unborn child at risk.

Vaccines for polio, whooping cough and diptheria for example have been around now for a long time - at least two if not three generations, so I don't think that using the excuse that we don't yet know the impact is valid.

Psycho Milt said...

The decline has been the result of technical, social and hygienic improvements and especially of improved nutrition.I know my parents would be astonished to hear that the terrible threat of Polio that existed when they were children was due to the poor hygiene, social conditions and nutrition they had to endure in the 1940s...

Anna said...

I don't think it's just a matter of whether the likelihood of your child getting a particular disease is imminent. It's also about the effects of that disease on a largely unvaccinated population. Eg, the possibility of any of us getting swine flu is low, but if one person happened to introduce it to the country the impact on an unprepared population could be large (eg the Dutch village I mentioned earlier). And because the global population is more mobile than ever before, the chances are greater (even if still small).

I have no problem at all with people choosing not to vaccinate their kids for scientifically valid reason. For example, the meningitis vaccination appears to have limited usefulness, and the chances of contracting meningitis outside a certain social environment (South Auckland, Otago Uni hall of residence) aren't that high.

But I get irked when people base their decisions on pseudo-science like Jenny McCarthy's hair. It's not just their own health they're compromising - other people are affected to. I think this is an important ethical issue - there are sometimes good reasons why individual choice should give way to public safety, and the diminishing herd effect is surely one of them.

And by the by, yesterday I saw a Wellington pharmacy selling 'swine flu face masks' with the feeble caption 'prevention is best'. They were $25 each - bargain! (This was in a well-to-do suburb - aour my Lower Hutt home, no one gives a shit.)

Lucy said...

The vaccines are available to everyone at any point in their life and I don't see why we should be giving them to our children before they are able to consent, there is no immediate danger to any of us of getting any of the things that the vaccines carry because of the health standards we enjoy in this countryTell that to the one-week-old Australian baby who died of whooping cough because herd immunity had fallen too low. For some diseases, it is *vital* that vaccination occur at a very young age, because that's when you're at most risk. Measles is now endemic in Britain because vaccination rates fell too low. Give it long enough, and children will be crippled and killed by it. This is not acceptable.

Furthermore, it is an unacceptable reaction against a myth. Autism *has no link* to vaccination. A number of very large cohort studies have been done which confirm this beyond all doubt. Autism tends to *correlate* temporally with vaccinations - it generally becomes noticeable about the same time kids get their vaccinations - but it is unrelated. It's got a variety of causes, not all of which are well-understood - genetics, the womb environment, and *perhaps* vitamin D levels play a role - but vaccinations aren't one of them. The way anti-vaxxers keep moving the goalposts on the proof needed for them to be happy demonstrates this isn't about science, it's about belief. Unfortunately, it's a deadly belief, and one far more likely to be deadly for people who genuinely can't be vaccinated or don't have access to adequate healthcare than for the generally middle-class New-Agey idiots who think Jenny McCarthy has some sort of authority on this topic.

Anonymous said...

Personally I am not too comfortable when scientists - usually men - use their privileged positions to tell mothers that they don't know what is best for their babies.

A Nonny Moose said...

I read Phil Plait's "Bad Astronomy" blog, and he's gone in depth on the Jenny McCarthy vs Autism debate. He has lots of interesting things to say about it, and links to even better discussions. It doesn't mean much to me on a personal level, but I'm absolutely appalled that someone is using "Celebrity as Authority" to over-ride the voices of reason from science. Jenny McCarthy's partner is Jim Carrey who is using his position in Hollywood to just this advantage.

And Anonymous (the last comment): And I'm tired of the "Mother Knows Best" trope. There's a lot to be said about mothering intuition, but there's also plenty more to be said about being educated and informed. Willfully neglecting a child's immunization is not just a personal thing - if you want your child to move in society (ie: go to school), then you have to think about the ramifications of an unprotected child in group society.

I was immunized, but I still remember going through measles, mumps, and chicken pox all within an 18 month period as a child. And I STILL got shingles later in life. It's not just something a kid "must go through" - if we have the tools at hand, we owe it to them to minimize their suffering.

Trouble said...

Anonymous's comment about the privilege of science deserves exploration, though. It's that argument that explains to me why there's a gendered element to the popularity of alternative medicine. Nailing my colours to the flag here, I think rejecting science as a privileged masculine domain is about as harmful to women as it gets (imagine rejecting education or politics on those grounds), but science and its practitioners have a case to answer in the way it's been applied to women's health in the past.

The answer is more engagement by women in the sciences, not less. It's my job and responsibility as an upcoming parent to make decisions about my impending kid's health, but having that job doesn't magically give me the knowledge I need to discharge that duty. The better the tools I have to understand advice and put it in its proper context (backed by extensive studies, indicated by a bit of research, extrapolated from anecdata or what I heard from some celebrity advocate), the better I can do my job.

It's privilege (a good education in data interpretation) that gives me these tools, but it's a kind of privilege that doesn't rely on others being disadvantaged - the kind everyone should be clamouring for.

Anonymous said...

I think rejecting science as a privileged masculine domain is about as harmful to women as it gets (imagine rejecting education or politics on those grounds)I would answer the same way about medicine as I would about education or politics. We should struggle to remove masculine privilege from these arenas. But while they are strongholds of privilege, which is unquestionably the case right now, we should regard them with scepticism. You certainly wouldn't argue that women should do what politicians tell them to because they hope some day to break the masculine stranglehold on political power. It's exactly the same with medicine. The only difference is the way that privilege is exercised.

I find it interesting that you seem to feel a woman who disagrees with the medical 'authorities' about a specific treatment is disengaging from the sciences, though. If this is disengaging, how is it possible to resist while remaining engaged?

Anonymous said...

There's a lot to be said about mothering intuition, but there's also plenty more to be said about being educated and informed. So why are you assuming that mothers who disagree with the medical authorities are un-educated and uninformed?

A Nonny Moose said...

So why are you assuming that mothers who disagree with the medical authorities are un-educated and uninformed?Jenny McCarthy. Are you telling me she's educated and informed? Only in what she wants to BELIEVE.

There's a difference between faith and science.

I'm sorry, why are we arguing about the patriachy of medicine when the issue at hand is immunizing children? "I'm not going to immunize my children because my doctor has a penis, therefore he COULD be wrong". Headesk.

Immunization is based on science. Does it really matter whether it came from a man or a woman in the end? I KNOW this is a feminist blog, but that's putting children's health and risk, just for the sake of your trust issues.

Anna said...

Trouble - completely agree. Science is hardly infallible. It brought us thalidamide after all. And Plunket's changing ideas about how babies should sleep have actually increase SIDS at different times.

It's fine to point this out as feminists - but instead of throwing out the baby with the bathwater, we need to build on scientific insights to offer something better (NB Sandra Harding rocks on this topic!). When I was faced with an emergency caesarean or death, I was pretty happy to have modern science on hand.

Anonymous said...

Jenny McCarthy. Are you telling me she's educated and informed? Only in what she wants to BELIEVE.Well, in terms of education, according to her wiki page she studied nursing, so she's more educated on health issues than most commentators here.

As for whether or not she's informed, it seems you're arguing that her position is so dumb it can't possibly be informed. This is a bit of a catch 22 - opposing arguments are stupid because uninformed people hold them, and people who make stupid arguments can't possibly be informed, or why would they be so stupid?

Trouble said...

The way in which arguments are presented can give some clues as to their provenance. Published in a peer-reviewed journal - pretty good. Presented in a media campaign - not so good.

It was three medical researchers, a geneticist, a pediatrician and an obstetrician, who spotted the birth defects associated with thalidomide. A US pharmacologist prevented its widespread release in the states before its harm was known. Science isn't meant to be infallible - it's meant to have enough questioning built into it that the mistakes get spotted and fixed sooner or later.

A Nonny Moose said...

As for whether or not she's informed, it seems you're arguing that her position is so dumb it can't possibly be informed. Oh, I understand she's informed, but it's information she only WANTS to hear. This comes back to my statement about Belief - they're so unwilling to hear the other side of the story (away from media scaremongering, anecdotal evidence and snake oil), it's incredibly harmful.

While most parents aren't willfully being harmful to their kids, they can live in a little bubble of information - what their parents did before them, what their friends say, what the media tells them, what's said on the Internet (a mine field of disinformation), what a doctor advises. Sure, NONE of these sources are infallible. But it's difficult to put forward the concept of change, or having to go against the advice of your mum (for example).

As said before, Science may not always be right, but I'd trust them over prayer, promises and hope.

Anonymous said...

I'm sorry A Nonny Moose, I'd love to respond but I found your criticism of Jenny McCarthy for not wanting to hear the other side of the story so hilariously hypocritical I think I'm just going to chuckle some more and leave your last post to stand as it does - you do more to undermine your own argument than I ever could.

A Nonny Moose said...

How do you know I haven't listened to the other side of the story? I could tell you all about the reading and educating myself I've done, but I don't expect you to believe me.

hendo said...

An informative website by the parents of the baby that died from whooping cough in northern NSW (I am shocked about this because I grew up here): www.danamccaffery.com. It tells their story but, more importantly, it talks about how the lack of information about vaccination and the low vaccination rates created this situation.

I find the attitude of commenters like Jo and Anonymous really difficult to take. I'm afraid I'm like the writer of this post (Anna? sorry didn't check before hitting reply), I'm harsh on this issue. Your kid should get vaccinations unless there is a very good chance they'll have a reaction. End of story.

A Nonny Moose said...

Toni McCaffrey has also weighed in at Phil Plait's Bad Astronomy blog (I love that guy - amazing skeptic, head of the James Randi Foundation).

Some fantastic linkage and science flying around the debate over there, which I wish a lot of NZ anti-vaxxers would read.

I sometimes wonder if anti-vaxxers give up on the amount of scientific information available because it's too deep and not in everyday language.

http://blogs.discovermagazine.com/badastronomy/